Pham, Dominique

Pham, Dominique is an sole proprietor health care provider with primary practice located at 1996 Centre St , West Roxbury MA 02132-3329. He recently has 2 registered licenses in different health care specialties including Allopathic & Osteopathic Physicians / Internal Medicine, Allopathic & Osteopathic Physicians / Gastroenterology. Allopathic & Osteopathic Physicians / Internal Medicine is his primary health care specialty. Pham, Dominique can be contacted via phone (617) 469-0470.

Contact Information

Primary practice address
1996 Centre St West Roxbury MA 02132-3329
Phone: (617) 469-0470
Fax:
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Internal Medicine 207R00000X 74589 Massachusetts
Allopathic & Osteopathic Physicians / Gastroenterology 207RG0100X 74589 Massachusetts

Profile Details

NPI number 1891776662
LBN Legal business name Pham, Dominique
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 Yes
Enumeration date Nov 9th, 2005
Last updated Jan 14th, 2010 - about 16 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1891776662 NPPES
Massachusetts MEDICAID 3129063

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